Injections may be recommended for patients with urinary incontinence issues.
The process of moving urine out of the body involves a series of muscle contractions. If anything disrupts this process, urine may be involuntarily released through a tube called the urethra. When this happens on a regular basis, it’s a condition known as urinary incontinence.
- Initial treatment usually involves changes to diet, medication, and bladder-control techniques that may include Kegel exercises.
- If these treatments aren’t effective, a urologist may suggest injections.
When Injections Are Recommended
Both stress and urge incontinence may be managed with injections. Stress incontinence is usually triggered by actions such as laughter or coughing. Urge incontinence refers to an inability to hold urine until getting to a bathroom. There are two types of injections a urologist may use: intravesical OnabotulinumtoxinA injections and urethral bulking agents. Injections are usually recommended when exercises to strengthen pelvic floor and bladder muscles and medications that tighten bladder muscles or reduce contractions of the bladder aren’t preventing leaks or accidents.
Intravesical OnabotulinumtoxinA Injections
The FDA has approved the use of botulinum toxin for bladder leaks due to nerve damage. The procedure may also be used on patients with severe urge incontinence and issues with frequent urination not related to an underlying problem with the urinary system.
Prior to the injection of OnabotulinumtoxinA into the muscles of the bladder, patients are asked to urinate to empty their bladder. A local anesthetic gel is applied to the area to reduce sensitivity and minimize discomfort. The injection is administered with the use of a special lighted tube with a camera attached called a flexible cystoscope.
The cystoscope is inserted through the urethra into the bladder. Men may be asked to attempt to pass urine to make it easier to get the scope past the prostate gland. Sterile water is pumped into the bladder to allow for a better view by expanding the bladder’s lining. A series of injections are given during the procedure, which usually lasts about 15-20 minutes.
The injected toxin affects nerve endings in a way that prevents muscular contractions. Patients may temporarily experience burning sensations during urination for a day or two after a OnabotulinumtoxinA injection. Overall, however, risks are minimal. Patients may also be asked to look for signs of a urinary tract infection within the first few days after the procedure.
Urethral Bulking Agents
Administered under either general or local anesthesia, urethral bulking agent injections are placed around the urethra. A urologist may suggest this treatment to add bulk to the sphincter so a tighter seal in the urethra is formed to keep urine from leaking.
Bulking agents are injected into the side of the urethra. The injections may be done directly through the skin. In women, injections are sometimes done through the vagina. A cystoscope is inserted into the urethra to provide visual guidance to help with needle placement.
After the procedure is completed, patients are often asked to stand up to see if the urine leakage has stopped. If it hasn’t, another injection of the bulking agent may be given. It usually takes about half an hour to complete this treatment.
Should injections fail to sufficiently manage stress incontinence, surgery is sometimes recommended. The most common procedure involves the placement of a sling to lift the bladder to prevent urine leakage. Other options include the insertion of a latex or silicone device called a pessary into the vagina and the use of adhesive foam pads placed over the urethral opening. Some patients prefer to manage the problem with absorbent pads or underclothing.